Medicare is usually the third rail of electoral politics. Voters don’t like changes to the entitlement program, even when politicians suggest expanding it. And Iowa isn’t exactly a prime location to roll out big Medicare changes: Seniors make up 14.9 percent of the population there, compared with their 13 percent share nationally.

But that didn’t scare off Santorum. The former U.S. senator from Pennsylvania has, for months now, aggressively backed the Medicare changes that House budget chairman Rep. Paul Ryan (R) rolled out in April. That would be the plan that proposed privatizing the program and giving qualified recipients federal money to purchase health coverage. The plan was a political flop. Polls found that voters weren’t exactly keen to scrap the entitlement program as it exists now.

Most Republican candidates approached the Ryan plan with caution, if not outright criticism. Former House speaker Newt Gingrich didn’t mince words when he described it as “right-wing social engineering.” Mitt Romney, while praising the principles of the Ryan plan, ultimately proposed another version of Medicare reform, which would have a government-run plan compete against private options. And that looks a lot like the plan that Ryan, partnered with Sen. Ron Wyden (D-Ore.), rolled out last month.

But all along, Santorum has stood out in the GOP field as the Ryan plan’s biggest cheerleader. The day after Ryan rolled out his original plan, Santorum praised the House budget chairman’s ideas.

“I commend Chairman Ryan’s long-term budget proposal that tackles entitlement programs, particularly his proposed reforms of the Medicaid program,” Santorum said in a statement. “I also believe the Republicans’ approach to reforming Medicare is right on target to streamline the program, reduce waste and allow future Medicare beneficiaries to have more of a say in the needs of their benefits with a market driven approach.”

Santorum has endorsed the Ryan-Wyden plan, too. But he has also argued against the exact policy feature that makes the plan politically palatable: the guarantee that the government-run Medicare of today will still be around tomorrow. The day before the Iowa caucus, Santorum criticized the idea of public option in the Medicare program during a town hall speech. “I have a problem with the public option part that Ron Wyden has insisted on,” Santorum told Iowa voters.

In other ways, too, Santorum has gone against the political grain on Medicare. Last spring he described his vote to create Medicare Part D, a prescription drug coverage plan, as a mistake because it expanded the entitlement program. Most Republicans see the drug program as a success, one that has come in under budget as private health plans compete for seniors’ business, all the while getting high marks from the elderly population it serves.

How does a candidate who wants to make big changes to Medicare find himself with a near-first place finish in Iowa? Santorum’s Iowa success may have little to do with Iowans’ opinions on his Medicare policy. Instead, it could be that Hawkeye voters weren’t thinking much about health policy at all. Early exit polls showed that just 4 percent of Iowa voters considered health care as their biggest concern. Nearly a third of Santorum voters listed abortion as their key voting issue.

Santorum never weathered much of an attack for his views on Medicare in the way that other Republicans have faced (Exhibit A: The NY-26 special election last spring, where Democrats defeated a GOP contender with aggressive attacks on her support for the Ryan plan). And he hasn’t gotten much attention for his Medicare policy from his campaign competitors or even from Democrats.

But the former senator’s could see his Medicare proposals come under more scrutiny, as voters take a fresh look at the Republican field coming out of its first electoral contest.

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